I had never really appreciated the importance of eating. Usually, I grab a quick meal at the hospital cafeteria and inhale it while reading the newspaper or the Internet before getting on with my day.
Ironically enough, a few days ago during my lunch break, a CNN article titled "Doctors grow a new jaw in man's back" caught my eye, and it immediately sounded to me like someone was trying to get a jump on life by learning to eat twice as fast. It was, in fact, a very serious undertaking.
The Aug. 28 edition of The Lancet medical journal published a report on how Dr. Wernke and a team of physicians undertook the challenge of replacing a man's jaw with a new jaw grown on his own back. Significantly, this was the first time a whole bone was grown inside a person's body and then transplanted elsewhere within his body.
This man had a large portion of his lower jaw and half his tongue removed because of oral cancer. When his jaw was initially removed, a titanium plate was placed as a bridge over the gap that was made, but it was not nearly as functional as a real jaw. He couldn't eat anything but mush or soup after the operation, and he became "sick of living," according to Wernke, the head surgeon on his jaw replacement team.
Because of his lengthy medical history, the patient did not have many plausible treatment options available to create a functional jaw. Previous chemotherapy and radiation therapy had made him weak and damaged the soft tissue around his face. Using artificial bones would pose too much of a risk because of his increased chance of infection due to his weakened immune system. Also, prior vascular and heart conditions had made it necessary for him to be placed on a powerful blood thinning agent, warfarin, which added additional risk to any operation. Therefore, taking a bone graft, which is another common procedure, was too risky because of potential bleeding problems and additional bone damage.
With all of the obstacles they faced, Wernke's team of doctors had to think creatively about how to treat this man and improve the quality of his life. With the help of computer tomography scans and three-dimensional computer imaging, they developed a titanium mesh jaw scaffold that would fit into the gap in his jaw. In that scaffold they added a few pieces of bone mineral blocks, bone marrow stem cells and BMP7, a growth factor that induces bones to differentiate and grow. They took this mesh scaffold and surgically placed it into his right latissimus dorsi muscle, the muscle around the shoulder blade on the back. This was a prime location because it utilized the blood supply of the shoulder blade area, which is very heavily vascularized, to help the growth of the bone within the scaffold. The implant was not aesthetically evident nor was it a great physical burden in terms of pain or range of motion.
For seven weeks, the developing bone was left to grow and solidify into the titanium mesh plate. Following the growth period, the titanium bone mesh was taken out of his back along with a piece of his latissimus dorsi muscle and a few pieces of blood vessel. The previously placed titanium bridge was removed from his jaw, and this meshwork of titanium, bone, muscle and blood vessels were inserted into his jaw with titanium screws. Several skin grafts were subsequently performed, and the bone continued to mineralize after it was inserted into his face.
While it vastly improved his life, many scientists are unsure about how much of an advancement this was because it is unclear how much of the bone growth was a result of the stem cells. Until enough bone is mineralized to safely take a biopsy sample from his jaw, no one can be sure how effective the stem cells were. Additionally, questions about the nerve growth, such as if he could ever feel his jaw, were never addressed, and such questions will determine the long-term viability of his jaw. Optimistically, this is a step toward advancements such as growing organs or body parts within human bodies.
Of paramount importance, four weeks after the surgery, although still toothless, the patient ate his first solid meal in about a decade, a bratwurst sandwich. Barring any complications, the patient was promised the titanium plates removed and teeth implanted into the bone of his lower jaw in about a year. Now that's something to chew on.
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